� Paediatric oncology outreach-programs have been effective development interventions to reduce inequalities in healthcare between highincome countries (HIC) versus low and middle-income countries (LMIC). Little is known about their sustainability during times of a pandemic � This study assesses the impact of COVID-19 government measures on a paediatric oncology outreach-program between three large referral hospitals in Netherlands (HIC), Indonesia (LMIC) and Kenya (LMIC) � COVID-19 government measures have impacted childhood cancer care at all three hospitals. However, disruptions in services are more prominent at partner sites in LMIC, increasing existing inequalities � COVID-19 government measures have adversely affected the wellbeing of children with cancer in both HIC and LMIC, and the chances of survival of children with cancer in LMIC � Government leaders and policy makers should take collateral damage of their COVID-19 policies and local settings into account to protect children with cancer in LMIC